The Alli way

The US Food and Drug Administration (FDA) has approved the weight-loss drug orlistat (tetrahydrolipstatin) for over-the-counter (OTC) use. Previously available only by prescription under the already interesting trade name Xenical (which sounds much like the name of an African country with a lot of really thin people), GlaxoSmithKline, formerly SmithKline Beecham Glaxo Burroughs Welcome to the Machine or something, has dubbed the OTC preparation Alli, which hopefully will not inspire a practice of naming drugs after women or vice-versa. (Overheard on the subway: “Well, every night I take Beverly, Monica and Lisa, usually all at once and with food. And oh, Roz — twice a day when I can be bothered.” “Man, I popped Alli last night and made a huge stinking mess of the bathroom.”)
The drug works by blocking the action of pancreatic lipase, an enzyme which breaks down triglycerides — large molocules that include three fatty acids bound to a three-carbon glycerol “backbone” — into free fatty acids. Triglycerides put the calories in dietary fats; the gut can’t absorb them, but avidly absorbs free fatty acids. So if you eat fats that can’t be enzymatically broken down, your body can’t use them for nourishment for the same reason you gain no energy from eating paper, cotton, and other plant matter even though cellulose is nothing but a string of glucose monomers — the intestine isn’t equipped to absorb the larger molecules (polymers). As a result, about 30% of ingested fats are not absorbed when users take a standard dose of orlistat before meals.
Engineering geniuses and Sherlock Holmes fans may at this point accurately guess another result: Users shit grease. Think of Alli as an Olestra-laden snack without the taste or the substance.

For some of us this is merely a grand party trick, but for others it is potentially embarrassing, which is why I recommend never taking a dump in full view of the public.
As noted in a study ending in 2004 and published in Diabetes Care, the drug has been shown to be helpful in preventing the onset of diabetes. 6.2% of roughly 1,500 patients treated with Xenical developed diabetes over a four-year period, compared to 9% of a similar number of people on a placebo — a 37% reduction in risk.
But who cares? There’s no humor in that. From a Chicago Tribune story:
“Eating too much fat increases the likelihood of what one expert described as “totally socially revolting” digestive side effects. For example, about one-quarter of patients experienced oily, spotting bowel movements while taking the drug.”
Help me out — how is this socially revolting unless you routinely have people grade your bowel movements on the basis of aesthetics? We’ve all heard the phrase “So-and-so walks around like his shit doesn’t stink,” but this idiom isn’t rooted in people with inflated self-images getting that way as a result of waving odorless turds around at social gatherings.
Opponents of the drug (and of weight loss in general) are ignoring the benefits claimed in the Diabetes Care paper and focusing on the fact that long-term users lost an average of only six pounds more than non-users. They are claiming, probably accurately, that non-obese teenagers are apt to abuse the drug in a search for leanness. Blog entries like this one, however, are nothing but raw hysteria. There aren’t a lot of diet-happy teenagers undergoing organ transplants or taking blood thinners (and here one should be checking the Xarelto lawsuit update, obviously); orlistat is not phen-fen — a cardiotoxin the FDA clearly never should have approved; and invoking the FDA’s handling of Plan B in the context of orlistat is as inane as yammering about “Darwinism” giving rise to Stalinism and other social iniquities.
Moreover, if teenagers want much more dangerous OTC products to harm themselves with, they’re already out there. Perenially popular laxatives, for example, can cause severe — even fatal — electrolyte disturbances and other problems. Orlistat won’t do much of anything unless you’ve already eaten a high-fat meal.
But on the whole I agree with both the medical professonals who emphasize that this drug is to be used only as an adjunct to exercise and sane dietary practices and the hystericals who say it’s not necessary, albeit for different reasons. As this is a pill that can only work its “magic” if people are neglecting to behave as they’ve already been advised to behave, it’s simply one more excuse people will use to stick to shortcut-seeking.

14 thoughts on “The Alli way”

  1. The problem with Olestra, and possibly with the side effects of “Alli”, is leakage. My understanding is that sometimes things can “sneak out”, which would indeed be totally socially revolting.
    I don’t like the quick-fix suggestions either, for a very large number of reasons I won’t go into here.

  2. When is this drug projected to hit the market? It will be interesting to see how the hype about it goes as people get access to it, expect to be size 2 overnight, and then actually experience the side effects/non effects of the ‘miracle drug’.

  3. This drug seems weirdly ironical. If you eat the lipids it renders indigestible, it may make your ass leak; the anus is not suited to retaining oily fluids. If you don’t eat those lipids, it won’t change the number of calories you derive from food.
    My forecast: In 5 years the producers will realize this drug can’t recoup their investment, and abandon it.
    However I’m no doctor nor nutritionist. If I’m wrong about the anal leakage, my forecast will be bust.

  4. Eh, the anal leakage angle is overblown. As part of an informal experiment on myself on how diet impacts the clearance of a lipophillic metabolite that typically exits through the bowels, I once ate half a full-sized bag of olestra-containing potato chips a day for two weeks. While it certainly didn’t improve the quality of my bowel movements, it didn’t cause anything unmanagable – I ultimately stopped not because of GI side effects but because I couldn’t stand eating so many potato chips.

  5. I once ate half a full-sized bag of olestra-containing potato chips a day for two weeks.

    This is bush league.
    Try eating about two gallons of homemade French Onion Soup and then do some work in your front yard like a man.
    That’ll show ya some leakage like a fire hose.

  6. ok, if Bill thinks it takes TWO GALLONS (wow!) of homemade French Onion Soup and some yard work to cause problems, I will take back my ignorant forecast.

  7. orlistat is not phen-fen — a cardiotoxin the FDA clearly never should have approved
    I take issue with this; I don’t think it was as clear-cut an issue as you seem to think it was.

  8. Another negative side effect of Orlistat is that it may prevent the absorption of some dietary vitamins and supplements which need fat be absorbed by the body like vitamins A, D, E and beta- carotene. So people that take it also need to take multivitamins.

  9. Brian —
    I worded the passage in question poorly. I should not have implied, as it appears I did, that the FDA was allowing a known cardiotoxin into the hands of consumers (and to be accurate, I am 99.44% certain the FDA never actually approved a combo of fen and phen — that was an “off-label” thing docs were doing, so I was misleading there as well).
    However, phentermine (the non-cardiotoixic component; a schedule IV drug in the U.S.) was a known beast from its Pondimin days; none of these speed-like drugs has ever proven free enough of the whole palette of sympathomimetic effects to make them beneficial as diet drugs. And even in early 1997, many months before a whopping 30% of users (in one survey) were found to have screwy echocardiograms from the fenfluramine, I remember seeing somber heads on TV talking about specific problems with the combo.
    Sound more reasonable?

  10. I’m not too sure what I think of the drug, though the side effects are definitely something to take into account. I have to say I don’t like any of the names though. Orlistat sounds like a brand name rather than a drug name, Xenical sounds like something that would be advertised on late night TV with a hefty dose of ephedra and a standard “the FDA has not evaluated…” disclaimer, and Alli just sounds like someone’s daughter.

  11. Food & Drug administration now there’s an oxymoron. Why would put the same folks in charge of our Food and our Drugs? (JOe had no comment)

  12. Food & Drug administration now there’s an oxymoron. Why would put the same folks in charge of our Food and our Drugs? (JOe had no comment)

  13. Food & Drug administration now there’s an oxymoron. Why would put the same folks in charge of our Food and our Drugs? (JOe had no comment)

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